Evaluating the combination of the Adolescent Community Reinforcement Approach and medication- assisted treatment in young adults with severe opioid use disorder Project Summary The proposed study will assess whether adding a behavioral intervention, known as the Adolescent Community Reinforcement Approach (A-CRA), to the treatment of individuals receiving buprenorphine/naloxone can improve treatment success and retention rates in young adults with severe opioid use disorder. Forty young adults between ages 18 and 25 who would typically qualify for treatment with buprenorphine/naloxone at an academic outpatient site, will be randomized to receive 12 weeks of A-CRA treatment, or limited counseling. We plan to: (1) collect pre- and post-treatment assessments of opioid use and overall impact of addiction using the Global Appraisal of Individual Needs (GAIN) measures; (2) collect weekly urine drug screens; (3) measure treatment retention in all participants at weeks 2, 12, and 24; (4) compare retention rates and treatment success measures between the experimental (combined treatment) and control (limited counseling) groups. The information generated from this study will provide evidence to support a tailored treatment approach for this high-risk demographic of individuals with opioid use disorder.